Revenue Cycle Prior Authorization
Resume:
Rita Givens, CPC
*********@***.***
Summary
To contribute to an organization in a role where I can utilize my experience as a Medical Biller, Reimbursement subject matter expert and Certified Professional Coder to manage the functions related to the coding, reimbursement and revenue cycle processes at both the individual provider level as well as the vendor level.
PROFESSIONAL EXPERIENCE
Discovery Behavioral Health, Irvine, CA (Contract) Jan 2024 - Jan 2024 Collections Coordinator
• Collection follow-up for Substance Abuse Inpatient claims for Anthem BCBS Blue Shield of California, Oakland, CA (Remote) Sept 2023 - Jan 2024 Customer Service Concierge
• Taking calls of members for all things regarding member benefits Zerigo Health, Inc. San Diego, CA (Remote) Aug 2020 - Apr 2023 Reimbursement, Revenue Cycle Manager/Enrollment Manager
• Report to Director of Member Services
• Created processes, standard operating procedures specific to narrowband UVB phototherapy DME product in order to code and authorize internally
• Work closely with third party Billing Company to streamline benefit verification, prior authorization and the claims process
• Reduced prior authorization timelines by greater than 50% within 2 months of implementing in-house Benefit Investigations and prior authorizations program
• Worked with both Inside and Outside Sales to reinforce appropriate billing, educate on medical policy criteria for both Government and Commercial payers
• Managed Enrollment department for new business model which included creating new processes for enrolling Employer Members to receive UVB phototherapy device
• Worked across departments for smooth transition from DME model to Employer based model
• Updated state licensing for the purpose of shipping devices across the nation
• Worked closely with a consultant to gather information for ACHC Accreditation renewal HeartFlow, Inc., Redwood City, CA (remote) Aug 2018 - Aug 2020 Western U.S. Field Billing Specialist
• Supported Sales team, Implementation Managers, CT Applications Managers, and IT Managers to help onboard new clinics for HeartFlow FFRCT Analysis by conducting field visits to minimize and overcome reimbursement barriers and educate appropriate coding/billing practice
• Developed educational coding and reimbursement marketing materials for organization
• Worked closely with Market Access Regional Account Managers for Payer Relations pull through programs with each hospital/health system client
• Participated in all District Sales Managers meetings to ensure account development and reimbursement education
• Responsible for all appeals for prior authorization and claims denials
• Identify OPPS reimbursement to ensure appropriate wage adjusted rate for FFRCT Analysis
• Survey and manage third-party billing’s revenue cycle process to ensure claims are submitted clean, timely and reasonable based off organization protocols
• Worked in conjunction with Director of Payer Relations regarding contracted payers to ensure contracts are loaded properly and education on pull-thru for entire organization to track and trend reimbursement issues per payer
iRhythm Technologies, Inc., San Francisco, CA (Remote) July 2013 - July 2018 Western U.S. Field Billing Specialist
• Supported Sales organization to educate physician providers, clinics and staff on reimbursement, coding, and billing for the ZioPatch Ambulatory Cardiac Monitor through field visits as necessary or virtual meetings
• Held 1:1’s with each Sales Representative, Regional Sales Directors, Director of Payer Relations and Revenue Cycle for all reimbursement education and billing concerns
• Worked in conjunction with Directors of Payer Relations regarding contracted payers to ensure contracts are loaded properly and education on pull-thru for entire organization through tracking and trending reimbursement
• Worked with internal teams to coordinate on-boarding of new providers and clinics as well as any issues regarding any education for billing.
• Trained clinic personnel how to register patient information into iRhythm’s EHR
• Coordinated with clinic personnel on any missing clinical information regarding patient registration
• Trained all new Sales personnel on coding and reimbursement EDUCATION
AAPC Member – Certified Professional Coder, 2016
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